Comparative outcomes of transthoracic versus transhiatal eso
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Surgical resection has become a mainstay of therapy for locally advanced esophageal cancer and can increase survival significantly. This study suggests that the transthoracic approach is associated with fewer complications.

A prospectively managed esophagectomy database was queried for patients undergoing transthoracic or transhiatal esophagectomy. Continuous variables were compared using the Kruskal-Wallis or the analysis of variance tests as appropriate.

A total of 846 patients underwent esophagectomy with a median age of 66 years.

--There was no difference in estimated blood loss for transthoracic and transhiatal, but mean operating room times were longer for transthoracic versus transhiatal, and the number of retrieved lymph nodes was higher for transthoracic versus transhiatal.

--Postoperative complications occurred in 207 transthoracic patients vs 59 transhiatal patients. The most common complications in transthoracic versus transhiatal techniques, respectively, were anastomotic leaks: 4.3% vs 9.8%, anastomotic stricture 7% vs 26.5%, and pneumonia 12.6% vs 22.7%.

--Median survival significantly improved in patients undergoing transthoracic (62 months) vs transhiatal (39 months).

Researchers found that a transthoracic approach was associated with lower pneumonia, anastomotic leaks, wound infections, and strictures, with an improvement in the nodal harvest. Survival was also significantly improved in patients who underwent transthoracic esophagectomy.